A retrospective study of 41 patients who had anterior spinal column reconstruction using long-segment allografts between 1983 and 1998 is reported. A long-segment allograft was defined as an allograft strut that replaces a vertebral body or approximates the height of the adjacent vertebral body for the thoracolumbar or lumbar spine, or more than two vertebral bodies for the cervical or cervicothoracic spine. Forty of the 41 patients had successful anterior strut grafting with radiographic evidence of allograft incorporation at the last followup with the majority of patients having radiographic evidence of incorporation by 6 months. There where three early complications related to the allograft (two end plate fractures and one repeated cervical spine allograft dislodgment) and one late complication associated with the posterior adjunct instrumentation unrelated to the allograft (degenerative lumbar stenosis). The only procedural complication was a deep venous thrombosis and a resultant nonfatal pulmonary embolus. No allografts fractured or collapsed. These data suggest that long-segment anterior allografts work exceptionally well in maintaining vertebral height and structural integrity in numerous pathologic deformities including traumatic and infectious etiologies.